Sexual behavior, knowledge of STI prevention, and prevalence of serum markers for STI among tour guides in Cuzco/Peru

BACKGROUND: Sexual behavior during travel has increasingly become a focus of travel medicine research. The perceived freedom when away from home can lead to increased casual sexual activities, often unprotected. Local sexual partners, particularly those who are in close contact with tourists due to their occupation, need to be considered more in research. The purpose of this study was to explore the sexual behavior, knowledge of STI prevention, and prevalence of serum markers of selected STIs in tour guides in Cuzco/Peru. METHODS: In this cross-sectional study, 161 tour guides completed a questionnaire consisting of information on demographics, sexual behavior, and knowledge about STI prevention. Blood samples of the participants were tested for antibodies against HSV2, Chlamydia trachomatis, and Treponema pallidum using commercial enzyme-linked immunosorbent assay kits. RESULTS: The majority of guides (65%) were sexually active during the year prior to the study and 10% had foreign partners. Consistent condom use was reported by 38.1%, but almost 42% did not use condoms. In total, 27.6% reported symptoms compatible with STI. Three quarters of the participants had previously received information on STI prevention, predominantly from health professionals. In total, 22% considered themselves at high risk for STI. Antibodies against C trachomatis were prevalent in 15%, while 88.2% were against HSV2. None had antibodies against T pallidum. CONCLUSIONS: There is an inconsistency in reported sexual behavior and reported knowledge about STI prevention. Because of the tour guides' bridging position between potential STI carriers in tourists and the local population, the reported nonuse of condoms is of concern. The prevalence of serum markers supports this concern, which is aggravated by the potential of noncurable infections. Current sexual health education strategies seem unsatisfactory, and major modifications are highly recommended.     

Sexual risk behavior of travelers who consulted a pretravel clinic

Objective.  The objective of this study was to determine to which degree travelers who received pretravel advice at a travel clinic have protected or unprotected sexual contact with a new partner and what factors influence this behavior.
Method.  An anonymous questionnaire was sent to travelers who came to a pretravel clinic between June 1 and August 31, 2005. Risk factors for casual travel sex and predictors of protected sex were studied in a multivariate model.
Results.  A total of 1,907 travelers were included (response rate 55%) in the study. Only 4.7% of the respondents had sexual contact with a new partner, and 63.1% of these new partners were from the country of destination. Of those who had casual travel sex, 52.4% did not expect this (women 75%), 30.9% did not always use condoms, and 41% were not protected against hepatitis B. Independent risk factors for casual travel sex were traveling without steady partner (OR 14.4), expecting casual travel sex (OR 9.2), having casual sexual contacts in the home country (OR 2.4), non-tourist journeys (OR 2.2), being male (OR 2.1), the fact that the information on sexually transmitted infections (STI) had been read (OR 2.0), and traveling to South and Central America (OR 2.0). Taking condoms along (OR 5.4) and reading the information on STI (OR 3.3) were identified as independent predictors of protected sex.
Conclusions.  Travelers have substantial sexual risk behavior. Casual sex is usually not expected, and the most important predictor is traveling without a steady partner. We would advice every client of a travel clinic who will travel without a steady partner to read the STI information, to take condoms along, and to be vaccinated against hepatitis B.     

Sexually Transmitted Diseases Diagnosed Among Travelers Returning from the Tropics

Objectives.  Data are lacking on the spectrum of sexually transmitted diseases (STDs) diagnosed in returning travelers.
Study Design.  All consecutive travelers consulting our tropical unit between November 1, 2002 and October 31, 2003 were included if they presented within 1 month after their return from the tropics, with mucocutaneous signs suggesting STDs.
Results.  Forty-nine patients (12 women and 37 men; median age 36.4 y, 35 heterosexuals) were included. Four patients had traveled with their usual sexual partner and 45 patients had casual sex while abroad (31 with locals and 14 with other tourists). The main diagnoses were gonococcal urethritis ( n = 18), herpes simplex virus 2 infection ( n = 12), urethritis of undetermined origin ( n = 9), Chlamydia trachomatis infection ( n = 4), primary syphilis ( n = 4), and primary human immunodeficiency virus infection ( n = 2).
Conclusions.  These results illustrate the broad spectrum of STDs contracted by travelers to the tropics. They suggest the need to also inform travelers of the risks of STD and to promote the use of condoms in case of casual sex while abroad.     

Sexually Active Adolescents and Young Adults: A High-Risk Group for Chlamydia trachomatis Infection

Background: The importance of travel as a risk factor for Chlamydia trachomatis infection was evaluated among a series of young people consecutively tested.
Methods: We studied 130 sexually active young subjects, aged 14–25 years, all living in the Rome, Italy, urban area. Ninety-eight females and 32 males attended hospital-based clinics or were the partners of an infected female. About half of these subjects had traveled abroad either for pleasure or for work, mostly to Europe, but also to North America or to Asia, where they admitted to having had casual sex. We used two "gold standard" methods to diagnose infection with C. trachomatis : culture on McCoy cells grown in shell vial, and direct immunofluorescence with monoclonal antibodies. Subjects were considered infected when at least one test was positive.
Results: Thirty-nine of 130 (30%) subjects were asymptomatic, and 27/130 (20.8%) subjects were infected with Chlamydia trachomatis , of whom 6/25 (24%) asymptomatic females and 3/14 (21.4%) asymptomatic males were infected. Among teen-aged (ages 14–19) youngsters with more than one sex partner, international travel was an additional significant risk factor for C. trachomatis infection (p <.02; OR 20; 95% Cl 1.47–40%). Urethritis/cystitis and vaginal pathology/discharge were the prevalent manifestations of illness among the females, while urethritis was the only clinical condition found in the males.
Conclusion: In a series of young subjects, travel abroad, sex with more than one partner, and teen age, combined together, were significant risk factors for the acquisition of Chlamydia trachomatis genitourinary infection.     

Sexual behavior in travelers visiting Cuzco

BACKGROUND: In South America, little is known about sexual behavior and risk factors for acquiring sexually transmitted diseases (STDs) among travelers and among local people sexually interacting with travelers. There is evidence that, in Peru, significant sexual interaction between these groups exists. METHOD: An anonymous written questionnaire was administered to travelers in the airport and bus stations before they left Cuzco. RESULTS: Of the travelers,5.6% engaged in sexual activity with a new partner during their stay in Cuzco. Sexual intercourse with other travelers was most common (76/140, 54.3%), followed by sex with local partners (57/140, 40.7%), and with commercial sex workers (3/140, 2.15%). Consistent condom use was reported by 97/140 (69.3%). In the multivariate analysis, the following variables were independently associated with casual sex: male gender, single marital status, age between 15 and 35 years, non-United States travelers (NUSTs), traveling alone or with friends, length of stay more than 30 days, homosexual or bisexual orientation, and expectation of having sex before traveling. Homosexual and bisexual travelers had 3 or more new sexual partners more frequently than heterosexual travelers (4/8, 18/129, OR=6.17 (1.16相似文献   

Malaria Prophylaxis in Different Age Groups

Background: There is a perceived increased health risk in senior visitors to malaria endemic countries.
Methods: The authors sought to compare effectiveness and tolerability of malaria chemoprophylaxis in senior travelers (≥60 years) with those in younger travelers (20–59 years). The "Malpro 2" database consists of more than 100,000 questionnaires completed by travelers on charter planes returning from East Africa to Europe during July 1988-December 1991. Among them, 9106 (9.1%) of the travelers were 60 years or older, and 84,562 (84.6%) of the travelers reported to be 20–59 years. Variables of demography, travel data, and the effectiveness and tolerability of chemoprophylaxis were compared in the two subgroups.
Results: Malaria in Africa was reported by 8 (1/1000) elderly travelers and by 189 (2.2/1000) travelers aged 20–59 years. Adjusting for age, sex, prophylaxis, and duration of stay in Africa in a logistic regression model, malaria was significantly more frequent in younger than in senior travelers (p<.05). Any travel-associated illness was reported by 7.0% in the senior age group and by 13.6% in the younger age group (p<.05). The rates of travelers who indicated they had "side effects" attributable to malaria prophylaxis varied between 9.7% in the elderly and 15.5% in the younger travelers (p<.05).
Conclusion: Senior travelers tolerate malaria chemoprophylaxis and visits to the tropics at least as well as younger travelers.     

The Risk of Malaria in Travelers to India

Background.  Several countries have reported a decline in malaria cases imported by travelers returning from India.
Methods.  We collected data on imported malaria for the period 1992 to 2005 from nine countries. Traveler statistics denominator data were obtained from the Indian Ministry of   Tourism.
Results.  The malaria case numbers declined from 93 cases per 100,000 travelers in 1992 to 19 cases per 100,000 travelers in 2005. The proportion of Plasmodium falciparum decreased steadily throughout the years. The proportion of Plasmodium vivax accounts for more than 80% of all cases of malaria in travelers to India. Deaths due to malaria were rare; only the UK and the United States reported deaths, a total of 16, between 1992 and 2005. The high-risk areas for malaria in India can be clearly identified using endemic malaria data. High-risk states are Chhattisgarh, Orissa, Jharkhand, West Bengal, Goa (mainly P vivax ), and the states east of Bangladesh.
Conclusions.  The decreasing incidence of malaria in travelers to India and the high proportion of P vivax support the current change in guidelines in some European countries advocating the use of the standby emergency self-treatment strategy or bite precautions plus awareness of risk instead of chemoprophylaxis. Otherwise in high-risk states, chemoprophylaxis should still be considered particularly in high-transmission seasons.     

HIV risk and the overlap of injecting drug use and high-risk sexual behaviours among men who have sex with men in Zanzibar (Unguja), Tanzania

BackgroundMen who have sex with men and inject drugs (MSM-IDU) are particularly vulnerable to HIV infection and have the potential to transmit HIV across multiple populations through their male and female sexual partners and injection drug-using partners.MethodsRespondent-driven sampling was used to recruit men who reported engaging in anal sex with another man in the past 3 months, aged ≥15 years, and living in Unguja, Zanzibar. Participants responded to a face-to-face interview about their HIV and injecting risk behaviours and were tested for HIV, Hepatitis B (HBV) and C (HCV) and syphilis.ResultsAmong the 509 MSM who enrolled in the survey, 14% (n = 66) reported injecting drugs in the past 3 months among which 66% used heroin, 60% used a needle after someone else had and 68% passed a needle to someone else after using it. MSM-IDU were significantly more likely to have two or more non-paying male receptive sex partners and to have engaged in group sex in the past month, to have symptoms of a sexually transmitted infection in past 6 months, to have been arrested or beaten in the past 12 months and to be infected with HIV and co-infected with HIV and HCV compared to MSM who did not inject drugs. MSM-IDU were less likely to have used a condom at last sex with a non-paid female partner, to know where to get a confidential HIV test and to have ever been tested for HIV compared to MSM who did not inject drugs.ConclusionMSM-IDU, and MSM in general, in Unguja practice multiple high-risk behaviours that put them at risk for blood-borne and sexual transmission of HIV and HCV infection. Targeted interventions for MSM-IDU must account for the overlap of high-risk sexual and drug-using networks and integrate injection drug use and HIV services.     

Risk of Hepatitis B for Travelers: Is Vaccination for All Travelers Really Necessary?

Objectives.  Behavioral studies in travelers suggest that 33% to 76% of all travelers to hepatitis B virus (HBV)–endemic countries are at risk for HBV infection. We study the incidence and risk factors for HBV infection in travelers.
Methods.  Retrospective analysis of the characteristics and risk factors of all reported acute HBV patients in Amsterdam, the Netherlands, from January 1, 1992, until December 31, 2003.
Results.  The estimated incidence in travelers from Amsterdam to HBV-endemic countries is 4.5/100,000 travelers. Two thirds of these patients were immigrants who lived in Amsterdam and who had visited their friends and relatives in their country of origin. In 12 years, only three Dutch short-term tourists contracted HBV while traveling, all by heterosexual contacts.
Conclusions.  Dutch tourists who travel to HBV-endemic countries run a very low risk of contracting HBV. Vaccination of short-term Dutch tourists is not necessary. Immigrants run a higher risk irrespective of travel or duration of travel. This group should be advised vaccination.     

Vaccination Strategies Against Hepatitis A in Travelers Older Than 40 Years: An Economic Evaluation

Background.  In recent years, the number of travelers aged >40 years who acquire hepatitis A while traveling has increased. Therefore, there is a need to review hepatitis A vaccination protocols in travelers. The aims of the study were to assess immunity levels to hepatitis A virus (HAV) in international travelers >40 years and to determine the least costly immunization strategy.
Methods.  A serological examination of HAV antibodies in 427 international travelers aged >40 years traveling endemic zones was carried out. The prevalence of antibodies in each age group was assessed. The costs of two preventive strategies, direct vaccination of all subjects (independent of the immune status) or screening and subsequent vaccination of susceptible subjects were compared. The critical value of prevalence (CVP) (the value at which the costs for the two strategies are equal) was calculated.
Results.  Total prevalence of HAV antibodies was 78.9% [95% confidence interval (CI): 74.8–82.5] and was 80.0% (95% CI: 73.8–85.2) in men and 77.9% (95% CI: 71.9–83.2) in women. There was a positive association with age. In the 40 to 49, 50 to 59, 60 to 69, and 70 to 95 years age groups, the prevalence rates were 62.6 (95% CI: 53.8–71.5), 76.8 (95% CI: 70.0–82.7), 91.7 (95% CI: 85.2–95.6), and 97.5% (95% CI: 87.4–99.6), respectively. The CVP was 58.4% using two doses of vaccine.
Conclusions.  The CVP was lower than the prevalence rate found in our international travelers. Therefore, we recommend systematic screening for HAV antibodies before selective vaccination of international travelers aged >40 years traveling to hepatitis A endemic zones.     

Screening for sexually transmitted infections in substance abuse treatment programs

OBJECTIVES: We evaluated the prevalence of the sexually transmitted infections (STIs) chlamydia and gonorrhea in clients at a methadone maintenance program and a residential detoxification program. METHODS: We collected urine specimens for chlamydia and gonorrhea ligase chain reaction testing and assessed sexual, substance abuse and STI histories. RESULTS: Of 700 subject assessments, 490 occurred among detoxification clients and 210 in methadone maintenance. Chlamydia trachomatis was detected in 5/700 (0.9, 95% CI=0.1-1.8%) and Neisseria gonorrhoeae in none. All chlamydia infected subjects were recruited from the detoxification program. Subjects reported high risk sexual behavior: 17% reported commercial sex exchange, and 22% reported inconsistent condom use with multiple sexual partners during the prior 2 months. CONCLUSION: Based on prevalence in Boston, MA, universal screening for STI in substance abuse treatments programs is not warranted. However, routine screening for younger substance abusers and in communities with high prevalence should be considered.     

Successful implementation of a nurse-led teaching programme to independently administer subcutaneous methotrexate in the community setting to children with Crohn's disease

Background  Methotrexate is increasingly used as a third line immunosuppression agent in children with Crohn's disease (CD). Methotrexate is traditionally administered in the hospital setting.
Aim  To set up a nurse-led education programme to teach children/their parents to administer subcutaneous methotrexate in the community.
Methods  All patients were given methotrexate over a 16-month period. Patient demographics including previous treatments were collected. A competency based teaching package was implemented by the inflammatory bowel disease nurse. Distances and travel times together with costings were calculated.
Results  Thirty two patients (19 male; 13 female) with a median treatment age of 11.96 years (IQR 10.67–13.92) were studied. Thirty of 32 (17 children, 13 parents) were independently administering methotrexate. The median return journey distance to hospital was 23 miles (IQR 14.4–42.4) taking a median time of 52 min (IQR 41.0–73.5) for each injection. The total patient travel saving was £10 537 (average £730 per patient) and nursing time saving was £12 808 with home administration (total saving £23 345).
Conclusions  This paediatric study demonstrates that methotrexate injections can be given successfully in the majority (94%) of patients with CD independently in the community, resulting in significant time and money savings for patients and health professionals alike.     

Gastrointestinal infection among international travelers globally

Background.  Data on relative rates of acquisition of gastrointestinal infections by travelers are incomplete. The objective of this study was to analyze infections associated with oral ingestion of pathogens in international travelers in relation to place of exposure.
Methods.  We performed a multicenter, retrospective observational analysis of 6,086 travelers ill enough with any gastrointestinal infection to seek medical care at a GeoSentinel clinic after completion of travel during 2000 to 2005. We determined regional and country-specific reporting rate ratios (RRRs) in comparison to risk in northern and western Europe.
Results.  Travel to sub-Saharan Africa (RRR = 282), South America (RRR = 203), and South Asia (RRR = 890) was associated with the greatest rate of gastrointestinal infections. RRRs were moderate (25–142) for travel to Oceania, the Middle East, North Africa, Central America, the Caribbean, and Southeast Asia. RRRs were least (<28) following travel to southern, central, and eastern Europe; North America; Northeast Asia; and Australasia. Income level of the country visited was inversely proportional to the RRR for gastrointestinal infection. For bacterial and parasitic infections examined separately, the regions group in the same way. RRRs could be estimated for 28 individual countries and together with regional data were used to derive a global RRR map for travel-related gastrointestinal infection.
Conclusions.  This analysis of morbidity associated with oral ingestion of pathogens abroad determines which parts of the world currently are high-risk destinations.     

Sensation seeking,alcohol use and sexual risk behaviors among men receiving services at a clinic for sexually transmitted infections

OBJECTIVE: Risk-prone personality dispositions are associated with alcohol use and high-risk sexual behaviors; however, the nature of these associations and their implications for sexual risk reduction interventions are not clear. This study examined a conceptual model of sensation seeking personality and alcohol expectancies as correlates of sex-related alcohol use and sexual risk behaviors. METHOD: Men (N = 350) seeking services from an innercity clinic that treats sexually transmitted infections (STI) completed measures of demographic characteristics, sensation seeking, alcohol outcome expectancies, alcohol use in sexual contexts and sexual behaviors, administered onsite at the clinic using audio-computer-assisted interviewing. RESULTS: Path analyses showed that sensation seeking was related to engaging in unprotected sexual intercourse with casual or one-time sex partners (i.e.,high-risk sex). Sensation seeking was also associated with stronger expectancies that alcohol use enhances sex. This association was related to alcohol use in sexual contexts which, in turn, was related to high-risk sex. Analyses also showed that alcohol outcome expectancies mediated the association between sensation seeking and alcohol use in sexual contexts. CONCLUSIONS: Alcohol use plays important roles in risks for sexually transmitted infections, particularly among high sensation seekers. Cognitive restructuring of alcohol outcome expectancies may offer an in-road for developing HIV-STI risk reduction interventions.     

High-risk cocktails and high-risk sex: Examining the relation between alcohol mixed with energy drink consumption,sexual behavior,and drug use in college students

Alcohol mixed with energy drink (AmED) consumption has garnered considerable attention in the literature in recent years. Drinking AmED beverages has been associated with a host of negative outcomes. The present study sought to examine associations between AmED consumption and high-risk sexual behaviors in a sample of young adults. Participants (N = 704; 59.9% female) completed an online survey assessing AmED consumption, other drug use, and sexual behavior. A total of 19.4% of the entire sample (and 28.8% of those who reported using alcohol) reported consuming AmED. Participants who reported consuming AmED were significantly more likely to report marijuana, cocaine, and ecstasy use. Those who reported consuming AmED also had increased odds of engaging in high-risk sexual behaviors, including unprotected sex, sex while under the influence of drugs, and sex after having too much to drink. Relationships between AmED consumption and sexual behavior remained significant after accounting for the influence of demographic factors and other substance use. Results add to the literature documenting negative consequences for AmED consumers, which may include alcohol dependence, binge drinking, and the potential for sexually transmitted infections via high-risk sexual behavior.     

Social injecting and other correlates of high-risk sexual activity among injecting drug users in northern Vietnam

BackgroundSexual risk and STDs are relatively high among injecting drug users (IDUs) in Vietnam. We sought to determine characteristics of sexually active IDUs and correlates of high-risk sexual practices among IDUs in Bac Ninh province in northern Vietnam.MethodsWe used data collected for a community-based cross-sectional pilot study to identify correlates of recent high-risk sex (>1 sex partner and inconsistent/no condom use in the past year). Factors associated with high-risk sex were identified using logistic regression.ResultsAmong 216 sexually active male IDUs, one third (n = 72) had engaged in high-risk sex within the last year. IDUs who reported injecting with others more frequently, having someone else inject their drugs at last injection, sharing needles or sharing any injection equipment were more likely to have reported recent high-risk sex. Factors independently associated with high-risk sexual activity were not injecting oneself [AOR: 2.22; 95% CI (1.09–4.51)], and sharing needles in the past 12 months [AOR: 2.57; 95% CI (1.10–5.99)].ConclusionsIDUs who inject socially and IDUs who share needles are likely to engage in high-risk sexual behaviours and may serve as an important bridge group for epidemic HIV transmission in Vietnam. In addition to messages regarding the dangers of sharing needles and other injection equipment, preventive interventions among newly initiated IDUs should also focus on reducing sexual risk.     

Hepatitis A Risk in Travelers

Background.  Traveling to highly endemic areas for hepatitis A is increasing while the immunization level in travelers has been shown to be low in the countries studied.
Methods.  In this population-based study, we have estimated the incidence rate of travel-related hepatitis A during 1997 to 2005 by use of the Swedish notification system of communicable diseases and an ongoing national database on travel patterns. We have also acquired airport-based immunization data from 2007.
Results.  During the study period, 636 cases of travel-related hepatitis A were notified. Traveling to East Africa was associated with the highest incidence rate (14.1 cases/100,000 person months), followed by the Middle East (5.8/100,000 person months), and India with neighboring countries (5.6/100,000 person months). Visiting Friends and Relatives (VFR) travelers represented 83, 91, and 70% of the cases to these three regions. By age-group, the highest incidence was found in children 0 to 14 years (3.1/100,000 travelers) where 88% of the cases were VFR travelers. Incidence rate in unprotected travelers to East Asia, North Africa, and the Middle East was 2, 12, and 18 cases/100,000 person months, respectively. In 2007, 79% of the travelers were immunized against hepatitis A.
Conclusions.  We conclude that travelers, and especially children, who are VFR in endemic areas constitute a high-risk group for acquiring hepatitis A infection, while the risk for unprotected tourists to East Asia is low.     

Alcohol and Risks for HIV/AIDS Among Sexually Transmitted Infection Clinic Patients in Cape Town,South Africa

Abstract

Alcohol use is prevalent in South Africa and alcohol use may be associated with higher risk for HIV transmission. This paper reports a study of the association between alcohol use and HIV risk-related behavior among 134 men and 92 women receiving sexually transmitted infection (STI) clinic services in Cape Town, South Africa. Participants completed anonymous surveys of demographic information, substance use, and sexual risk behaviors. Results showed that problem drinking was common among STI clinic patients; 58% of men and 28% of women scored above a cut-off of 9 on the Alcohol Use Disorders Identification Test (AUDIT) suggesting possible problem drinking and 46% of men and 19% of women scored above 12 on the AUDIT indicating probable drinking problems. For men, heavier alcohol use was associated with having multiple sex partners in the past month, less condom use, and having a history of sexually assaulting women. Among women, higher scores on the AUDIT were also related to having multiple sex partners as well as a history of exchanging sex for money or materials. The association between alcohol use and sexual risk behaviors in a population at high-risk for HIV transmission demonstrates the need for integrating alcohol risk reduction counseling with HIV prevention counseling among STI clinic patients in South Africa.     

A Study of Sexual Relationship Power among Young Women Who Inject Drugs and Their Sexual Partners

Background: To date, research applying the Sexual Relationship Power Scale (SRPS) has been limited to sexual risk behaviors. Objective: We measured levels of sexual relationship power and examined associations between sexual relationship power and injecting and sexual behaviors that place women at increased risk for blood borne infections. Methods: Using data from a cross-sectional study of young women who inject drugs (WWID) in San Francisco, USA, logistic regression analysis identified independent associations between SRPS and subscale scores (relationship control [RC] and decision making dominance [DMD]) and injecting and sexual behaviors. Results: Of the 68 young WWID, 24 (34%) reported receptive syringe sharing, 38 (56%) reused/shared a cooker to prepare drugs, and 25 (37%) injected someone else's drug residue during the three-months prior to enrollment. Most (60, 88%) reported condomless sex with main sex-partner, 8 (12%) reported transactional sex, and 36 (53%) had two or more recent sex partners. The median SRPS score was 2.98 (IQR: 2.65, 3.18), 3.23 (IQR: 3.23, 3.57) for RC and 2.40 (IQR: 2.20, 2.60) for DMD. No significant associations were detected between SRPS or DMD and injecting or sexual risk behaviors. After adjusting for gender and years injecting, for every one-point increase in RC, women had a 6.70 lower odds of recent condomless sex (95%CI: 0.92, 50.00, p = 0.06), and a 3.90 lower odds of recent transactional sex (95%CI: 1.22, 12.50, p = 0.02). Conclusion: Our study findings suggest that some components of sexual relationship power may play a role in sexual risk, but not in injecting risk.     

Imported typhoid fever in Switzerland, 1993 to 2004

Background.  In industrialized countries, typhoid fever occurs mainly in returned travelers. To determine the need for preventive strategies, eg, for vaccination, continuous monitoring is needed to assess where the risk for travelers is highest.
Methods.  To investigate where the risk for travelers to acquire typhoid fever is highest, 208 patients with typhoid fever and recent travel were matched with travelers' statistics collected by the Swiss Federal Office of Statistics.
Results.  At the beginning of the study period, up to 30 infections with Salmonella typhi were recorded per year in Switzerland. Since 2001, less than 15 confirmed cases per year occurred. A majority of the 208 (88.5%) typhoid cases were associated with recent travel. Countries with highest risk were Pakistan (24 per 100,000), Cambodia (20 per 100,000), Nepal (14 per 100,000), India (12 per 100,000), and Sri Lanka (9 per 100,000).
Conclusions.  We found that over a 12-year period (1993–2004), the travel-associated risk of typhoid fever is highest for destinations in the Indian subcontinent. All other regions showed a decline, most markedly in southern Europe. Our results suggest that typhoid fever vaccination should be recommended for all travelers to countries in South Asia. Otherwise, vaccination of tourists to frequently visited low- and intermediate-risk areas is not necessary, unless there are behavioral risk factors.